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Rapid responses are not indexed in PubMed and they are not journal articles. \u003Cem\u003EThe BMJ\u003C\/em\u003E reserves the right to remove responses which are being wilfully misrepresented as published articles.\u003C\/div\u003E \u003C\/div\u003E\n \n \u003Cdiv class=\u0022view-filters\u0022\u003E\n \u003Cform action=\u0022\/\u0022 method=\u0022get\u0022 id=\u0022views-exposed-form-bmj-rapid-responses-bmj-rr-article\u0022 accept-charset=\u0022UTF-8\u0022\u003E\u003Cdiv\u003E\u003Cdiv class=\u0022views-exposed-form\u0022\u003E\n \u003Cdiv class=\u0022views-exposed-widgets clearfix\u0022\u003E\n \u003Cdiv class=\u0022views-exposed-widget views-widget-sort-by\u0022\u003E\n \u003Cdiv class=\u0022form-type-select form-item-sort-by form-item form-group\u0022\u003E\n \u003Clabel for=\u0022edit-sort-by\u0022\u003ESort by \u003C\/label\u003E\n \u003Cselect class=\u0022form-control form-select\u0022 id=\u0022edit-sort-by\u0022 name=\u0022sort_by\u0022\u003E\u003Coption 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class=\u0022view-content\u0022\u003E\n \u003Cdiv class=\u0022views-row views-row-1 views-row-odd views-row-first\u0022\u003E\n \r\n\u003Cdiv class=\u0022node node-highwire-comment clearfix\u0022\u003E\r\n\r\n \u003Cdiv class=\u0022row rr-header\u0022\u003E\r\n\r\n \u003Cdiv class=\u0022rr-left-column\u0022 class=\u0022\u0022\u003E\r\n\r\n \r\n \u003Cdiv class=\u0022response-title\u0022\u003E\r\n \u003Ca href=\u0022\/rapid-response\/2011\/11\/03\/reis-informed-consent-only-issue\u0022\u003E\u003Ch3\u003ERe:Is informed consent the only issue?\u003C\/h3\u003E\r\n \u003C\/a\u003E\r\n \u003C\/div\u003E\r\n\r\n \r\n \r\n \r\n \u003Cdiv class=\u0022content\u0022\u003E\r\n\r\n \u003Cdiv class=\u0022response-body\u0022\u003E\r\n \u003Cdiv xmlns:rsp=\u0022http:\/\/schema.highwire.org\/Service\/Response\u0022 xmlns:nlm=\u0022http:\/\/schema.highwire.org\/NLM\/Journal\u0022 xmlns:msg=\u0022http:\/\/schema.highwire.org\/Service\/Message\u0022 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xmlns:hwp=\u0022http:\/\/schema.highwire.org\/Journal\u0022 xmlns=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022\u003E\n\u003Cp\u003E I agree with the concerns with the issue of informed consent and that\u003Cbr \/\u003E\nthis is not the only issue being debated on\u003C\/p\u003E\n\u003Cp\u003E Having dealt with patients and producers of at least 2 different\u003Cbr \/\u003E\nprimetime TV medical programs in Australia on occasions in the last 5\u003Cbr \/\u003E\nyears I do have concerns about how some of these programs have been made. \u003C\/p\u003E\n\u003Cp\u003E Some of the initial introduction of the TV producers is made by the\u003Cbr \/\u003E\ntreating doctors to make it look legitimate though often many consultants\u003Cbr \/\u003E\ndoes not appear to be fully aware of the implications of involving a\u003Cbr \/\u003E\ncommercial entity to what is effectively a private contractual\u003Cbr \/\u003E\nrelationship between a doctor and the patient.\u003C\/p\u003E\n\u003Cp\u003E The issue that the TV programme will be in a public dormain is rarely\u003Cbr \/\u003E\nfully explored by the producers in their dicussion with the patients to\u003Cbr \/\u003E\nget their consent. In fact for practical reasons, the actual process of\u003Cbr \/\u003E\ngetting consent from the patient is delayed long after the initial day of\u003Cbr \/\u003E\nadmission, say on the day of injury, such that there would have been hours\u003Cbr \/\u003E\nof footage of the initial consultation at the emergency department (when\u003Cbr \/\u003E\nthe patient is drugged up on narcotics) and several operations performed.\u003Cbr \/\u003E\nI dont know whether the TV station destroy the footage if the patient\u003Cbr \/\u003E\nultimately refused consent or just kept in cold storage for the future.\u003C\/p\u003E\n\u003Cp\u003E In terms of capacity to consent, while theoretically \u0022if anyone can\u003Cbr \/\u003E\nconsent for surgery then they should be good for consent for TV access as\u003Cbr \/\u003E\nwell\u0022, we often forget that most of the consent for procedure between\u003Cbr \/\u003E\ndoctors and patients is mostly influenced by the patient\u0027s trust and\u003Cbr \/\u003E\ngoodwill with the doctors, whereas the consent with the TV station is a a\u003Cbr \/\u003E\ntrue commercial contract which the TV station will take their entitement\u003Cbr \/\u003E\nto the fullest within the contract once it is signed. Patients do not\u003Cbr \/\u003E\nrealise that until they have a dispute with the TV station.\u003C\/p\u003E\n\u003Cp\u003E And then there is the issue of practicality and patient care, getting\u003Cbr \/\u003E\na film crew in operating theatre will involve at least 2 extra persons in\u003Cbr \/\u003E\nthe enclosed area and the surgical team have to watch them closely to\u003Cbr \/\u003E\nensure infection control is not breached (no matter how experienced thay\u003Cbr \/\u003E\nare at this, especially with all that camera and sound equipment). We all\u003Cbr \/\u003E\nknow that we should limit number of unnecessary staff in theatre during a\u003Cbr \/\u003E\ntotal joint replacement to reduce microbal load, so are the TV crew\u003Cbr \/\u003E\nessential staff?\u003C\/p\u003E\n\u003Cp\u003E Lastly, if someone can buy into a seat at the operating theatre, then\u003Cbr \/\u003E\nsimilarly patients can request their (non-paying) partner or children or\u003Cbr \/\u003E\ntheir pets to be present in the theatre during the operation; they (except\u003Cbr \/\u003E\nthe pets) would have more vested interest in the successful outcome of the\u003Cbr \/\u003E\nsurgery than some spectators who paid to be rubbing sterile shoulders with\u003Cbr \/\u003E\nthe surgeon\u003C\/p\u003E\n\u003Cp\u003E While I support the idea of demystifying the medical miracle, I do\u003Cbr \/\u003E\nnot see a circus as part of the solution\u003C\/p\u003E\n\u003C\/div\u003E\n \u003C\/div\u003E\r\n\r\n \u003Cdiv class=\u0022response-competing\u0022\u003E\r\n \u003Cp\u003E\u003Cstrong\u003ECompeting interests: \u003C\/strong\u003E\r\n I am learning to be an orthopaedic surgeon\u003C\/p\u003E\r\n \u003C\/div\u003E\r\n\r\n \r\n \u003C\/div\u003E\r\n \u003C\/div\u003E\r\n\r\n \u003Cdiv class=\u0022rr-right-column\u0022 class=\u0022\u0022\u003E\r\n \u003Cdiv class=\u0022response-date\u0022\u003E\r\n \u003Cstrong\u003E09 February 2011\u003C\/strong\u003E\r\n \u003C\/div\u003E\r\n\r\n \u003Cdiv class=\u0022response-author\u0022\u003E\r\n Shyan Goh \u003C\/div\u003E\r\n\r\n \u003Cdiv class=\u0022response-occupation\u0022\u003E\r\n Orthopaedic Registrar \u003C\/div\u003E\r\n\r\n \u003Cdiv class=\u0022response-other_authors\u0022\u003E\r\n \u003C\/div\u003E\r\n\r\n \u003Cdiv class=\u0022response-affiliation\u0022\u003E\r\n \u003C\/div\u003E\r\n\r\n \u003Cdiv class=\u0022response-address\u0022\u003E\r\n Sydney Australia \u003C\/div\u003E\r\n\r\n \u003Cdiv class=\u0022twitter-address\u0022\u003E\r\n \u003Ca href=\u0022https:\/\/twitter.com\/\u0022\u003E\u003C\/a\u003E \u003C\/div\u003E\r\n\r\n \u003Cdiv class=\u0022response-links\u0022\u003E\r\n\r\n \r\n \r\n \u003C\/div\u003E\r\n\r\n \u003C\/div\u003E\r\n\r\n \u003Cdiv class=\u0022rr-separator\u0022 class=\u0022clearfix\u0022\u003E\r\n\r\n \u003Cdiv class=\u0022light-grey-line\u0022\u003E\u003C\/div\u003E\r\n\r\n \u003C\/div\u003E\r\n\r\n \u003C\/div\u003E\r\n\r\n\u003C\/div\u003E\r\n \u003C\/div\u003E\n \u003Cdiv class=\u0022views-row views-row-2 views-row-even\u0022\u003E\n \r\n\u003Cdiv class=\u0022node node-highwire-comment clearfix\u0022\u003E\r\n\r\n \u003Cdiv class=\u0022row rr-header\u0022\u003E\r\n\r\n \u003Cdiv class=\u0022rr-left-column\u0022 class=\u0022\u0022\u003E\r\n\r\n \r\n \u003Cdiv class=\u0022response-title\u0022\u003E\r\n \u003Ca href=\u0022\/rapid-response\/2011\/11\/03\/informed-consent-only-issue\u0022\u003E\u003Ch3\u003EIs informed consent the only issue?\u003C\/h3\u003E\r\n \u003C\/a\u003E\r\n \u003C\/div\u003E\r\n\r\n \r\n \r\n \r\n \u003Cdiv class=\u0022content\u0022\u003E\r\n\r\n \u003Cdiv class=\u0022response-body\u0022\u003E\r\n \u003Cdiv xmlns:rsp=\u0022http:\/\/schema.highwire.org\/Service\/Response\u0022 xmlns:nlm=\u0022http:\/\/schema.highwire.org\/NLM\/Journal\u0022 xmlns:msg=\u0022http:\/\/schema.highwire.org\/Service\/Message\u0022 xmlns:c=\u0022http:\/\/schema.highwire.org\/Compound\u0022 xmlns:x=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022 xmlns:xs=\u0022http:\/\/www.w3.org\/2001\/XMLSchema\u0022 xmlns:e=\u0022http:\/\/schema.highwire.org\/Service\/HPP\/Expand\u0022 xmlns:idx=\u0022http:\/\/schema.highwire.org\/Service\/Index\u0022 xmlns:atom=\u0022http:\/\/www.w3.org\/2005\/Atom\u0022 xmlns:frz=\u0022http:\/\/schema.highwire.org\/Service\/Firenze\u0022 xmlns:xhtml=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022 xmlns:openSearch=\u0022http:\/\/a9.com\/-\/spec\/opensearch\/1.1\/\u0022 xmlns:hpp=\u0022http:\/\/schema.highwire.org\/Publishing\u0022 xmlns:app=\u0022http:\/\/www.w3.org\/2007\/app\u0022 xmlns:fs=\u0022http:\/\/sassfs.highwire.org\/Service\/Content\u0022 xmlns:l=\u0022http:\/\/schema.highwire.org\/Linking\u0022 xmlns:cache=\u0022http:\/\/sassfs.highwire.org\/Service\/Cache\u0022 xmlns:r=\u0022http:\/\/schema.highwire.org\/Revision\u0022 xmlns:req=\u0022http:\/\/schema.highwire.org\/Service\/Request\u0022 xmlns:hwp=\u0022http:\/\/schema.highwire.org\/Journal\u0022 xmlns=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022\u003E\n\u003Cp\u003E Christopher Ryan\u0027s key point is that the ethical test of whether it\u003Cbr \/\u003E\nis fine for paying spectators to enter the normally private relationship\u003Cbr \/\u003E\nbetween doctor and patient rests on the adequacy and comprehensiveness of\u003Cbr \/\u003E\nthe information given to patients before they consent.\u003C\/p\u003E\n\u003Cp\u003E He describes consent for treatment, films that will be screened only\u003Cbr \/\u003E\nto other doctors and medical students, and reality TV medical\u003Cbr \/\u003E\n\u0022infotainment\u0022 as examples where informed consent can and has taken\u003Cbr \/\u003E\nplace. \u003C\/p\u003E\n\u003Cp\u003E If being adequately informed is the main thing that matters here,\u003Cbr \/\u003E\nmany possibilities could open up for others to observe the doctor-patient\u003Cbr \/\u003E\nrelationship and the practices, emotions and trust that should be integral\u003Cbr \/\u003E\nto it. Doctors wanting to open up the list of suitable spectators in their\u003Cbr \/\u003E\nconsulting rooms and theatres in order to advance a good cause might\u003Cbr \/\u003E\nreconsider inviting cashed-up salespeople from pharmaceutical companies\u003Cbr \/\u003E\nkeen to gather vital information on expressed patient concerns, attitudes\u003Cbr \/\u003E\nto treatment and potential anxieties about everyday problems that might be\u003Cbr \/\u003E\nmedicalised. Why not also invite artists and photographers wanting to\u003Cbr \/\u003E\ncapture the looks of sick and worried people, and authors looking to note\u003Cbr \/\u003E\ndown authentic dialogue for their novel or movie script?\u003C\/p\u003E\n\u003Cp\u003E And what information should a surgeon have to give patients about\u003Cbr \/\u003E\nthose who successfully bid to watch them? What assurances can be given to\u003Cbr \/\u003E\nthe patients about these strangers\u0027 willingness to respect the\u003Cbr \/\u003E\nconfidentiality of what they witnessed, given that such assurances could\u003Cbr \/\u003E\nhardly be policed and that breaches could not attract any professional\u003Cbr \/\u003E\ndisciplinary action as occurs with medical and allied staff. Should the\u003Cbr \/\u003E\npatients be given character references about the observers? \u003C\/p\u003E\n\u003Cp\u003E Imagine if GPs routinely displayed silent auction notices in their\u003Cbr \/\u003E\nwaiting rooms inviting patients or anyone off the street to bid to sit in\u003Cbr \/\u003E\non their consultations and examinations of other (consenting) patients in\u003Cbr \/\u003E\norder to raise money for various good causes. To get sufficient\u003Cbr \/\u003E\ninterest, it\u0027s unlikely that offering the opportunity to witness a\u003Cbr \/\u003E\nprescription renewal or a blood pressure reading would attract much\u003Cbr \/\u003E\ninterest. But what about genital, rectal or breast examinations? We\u003Cbr \/\u003E\nmight object that these are qualitatively different and involve inviolable\u003Cbr \/\u003E\nbreaches of privacy. But a few patients may well consent -- supposedly\u003Cbr \/\u003E\nthe key issue here - if the money was going to a good cause. So why not? \u003C\/p\u003E\n\u003Cp\u003E And should the size of the bids be relevant to the ethical\u003Cbr \/\u003E\nconsiderations? Would $10 be enough to praise this fund raising\u003Cbr \/\u003E\ninitiative if no higher bids were received? $50? Or does it only become\u003Cbr \/\u003E\njustifiable when you can attract the sort of big money that someone like a\u003Cbr \/\u003E\nprominent neurosurgeon can pull? What is the minimum price for pushing\u003Cbr \/\u003E\nthe boundaries of the privacy of the doctor-patient relationship? \u003C\/p\u003E\n\u003Cp\u003E When patients attend a doctor or a health care facility, unless it is\u003Cbr \/\u003E\nin emergency circumstances or in parts of the world where privacy is a\u003Cbr \/\u003E\nluxury accorded only to the rich, the expectation is that during\u003Cbr \/\u003E\nconsultation or treatment, one should be attended to only by those\u003Cbr \/\u003E\nproviding medical care and their support staff. The presence of trainee\u003Cbr \/\u003E\ndoctors and nurses is also consistent with such expectations. Having\u003Cbr \/\u003E\nenough money to satisfy one\u0027s curiosity or other personal motive about\u003Cbr \/\u003E\nmedical matters hardly seems relevant.\u003C\/p\u003E\n\u003C\/div\u003E\n \u003C\/div\u003E\r\n\r\n \u003Cdiv class=\u0022response-competing\u0022\u003E\r\n \u003Cp\u003E\u003Cstrong\u003ECompeting interests: \u003C\/strong\u003E\r\n SC is the author of the article being commented on.\u003C\/p\u003E\r\n \u003C\/div\u003E\r\n\r\n \r\n \u003C\/div\u003E\r\n \u003C\/div\u003E\r\n\r\n \u003Cdiv class=\u0022rr-right-column\u0022 class=\u0022\u0022\u003E\r\n \u003Cdiv class=\u0022response-date\u0022\u003E\r\n \u003Cstrong\u003E07 February 2011\u003C\/strong\u003E\r\n \u003C\/div\u003E\r\n\r\n \u003Cdiv class=\u0022response-author\u0022\u003E\r\n Chapman \u003C\/div\u003E\r\n\r\n \u003Cdiv class=\u0022response-occupation\u0022\u003E\r\n professor of public health \u003C\/div\u003E\r\n\r\n \u003Cdiv class=\u0022response-other_authors\u0022\u003E\r\n \u003C\/div\u003E\r\n\r\n \u003Cdiv class=\u0022response-affiliation\u0022\u003E\r\n \u003C\/div\u003E\r\n\r\n \u003Cdiv class=\u0022response-address\u0022\u003E\r\n University of Sydney \u003C\/div\u003E\r\n\r\n \u003Cdiv class=\u0022twitter-address\u0022\u003E\r\n \u003Ca href=\u0022https:\/\/twitter.com\/\u0022\u003E\u003C\/a\u003E \u003C\/div\u003E\r\n\r\n \u003Cdiv class=\u0022response-links\u0022\u003E\r\n\r\n \r\n \r\n \u003C\/div\u003E\r\n\r\n \u003C\/div\u003E\r\n\r\n \u003Cdiv class=\u0022rr-separator\u0022 class=\u0022clearfix\u0022\u003E\r\n\r\n \u003Cdiv class=\u0022light-grey-line\u0022\u003E\u003C\/div\u003E\r\n\r\n \u003C\/div\u003E\r\n\r\n \u003C\/div\u003E\r\n\r\n\u003C\/div\u003E\r\n \u003C\/div\u003E\n \u003Cdiv class=\u0022views-row views-row-3 views-row-odd\u0022\u003E\n \r\n\u003Cdiv class=\u0022node node-highwire-comment clearfix\u0022\u003E\r\n\r\n \u003Cdiv class=\u0022row rr-header\u0022\u003E\r\n\r\n \u003Cdiv class=\u0022rr-left-column\u0022 class=\u0022\u0022\u003E\r\n\r\n \r\n \u003Cdiv class=\u0022response-title\u0022\u003E\r\n \u003Ca href=\u0022\/rapid-response\/2011\/11\/03\/rereshould-spectacle-surgery-be-sold-highest-bidder\u0022\u003E\u003Ch3\u003ERe:Re:Should the spectacle of surgery be sold to the highest bidder?\u003C\/h3\u003E\r\n \u003C\/a\u003E\r\n \u003C\/div\u003E\r\n\r\n \r\n \r\n \r\n \u003Cdiv class=\u0022content\u0022\u003E\r\n\r\n \u003Cdiv class=\u0022response-body\u0022\u003E\r\n \u003Cdiv xmlns:rsp=\u0022http:\/\/schema.highwire.org\/Service\/Response\u0022 xmlns:nlm=\u0022http:\/\/schema.highwire.org\/NLM\/Journal\u0022 xmlns:msg=\u0022http:\/\/schema.highwire.org\/Service\/Message\u0022 xmlns:c=\u0022http:\/\/schema.highwire.org\/Compound\u0022 xmlns:x=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022 xmlns:xs=\u0022http:\/\/www.w3.org\/2001\/XMLSchema\u0022 xmlns:e=\u0022http:\/\/schema.highwire.org\/Service\/HPP\/Expand\u0022 xmlns:idx=\u0022http:\/\/schema.highwire.org\/Service\/Index\u0022 xmlns:atom=\u0022http:\/\/www.w3.org\/2005\/Atom\u0022 xmlns:frz=\u0022http:\/\/schema.highwire.org\/Service\/Firenze\u0022 xmlns:xhtml=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022 xmlns:openSearch=\u0022http:\/\/a9.com\/-\/spec\/opensearch\/1.1\/\u0022 xmlns:hpp=\u0022http:\/\/schema.highwire.org\/Publishing\u0022 xmlns:app=\u0022http:\/\/www.w3.org\/2007\/app\u0022 xmlns:fs=\u0022http:\/\/sassfs.highwire.org\/Service\/Content\u0022 xmlns:l=\u0022http:\/\/schema.highwire.org\/Linking\u0022 xmlns:cache=\u0022http:\/\/sassfs.highwire.org\/Service\/Cache\u0022 xmlns:r=\u0022http:\/\/schema.highwire.org\/Revision\u0022 xmlns:req=\u0022http:\/\/schema.highwire.org\/Service\/Request\u0022 xmlns:hwp=\u0022http:\/\/schema.highwire.org\/Journal\u0022 xmlns=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022\u003E\n\u003Cp\u003E The idea of monetizing the spectacle of medicine raises some\u003Cbr \/\u003E\nintriguing possibilities, and could offset some of the rising costs of\u003Cbr \/\u003E\nhealthcare.\u003C\/p\u003E\n\u003Cp\u003E TV broadcasts of actual Emergency Departments, operating rooms,\u003Cbr \/\u003E\nchildbirth, etc. could compete with their counterparts from TV\u0027s fictional\u003Cbr \/\u003E\ndramas. Of course, the patients would share in the profits, in return for\u003Cbr \/\u003E\ntheir consent.\u003C\/p\u003E\n\u003Cp\u003E Eventually the military will also come to embrace the marketplace,\u003Cbr \/\u003E\nputting out for bid exclusive rights tobattle-field reporting. Isn\u0027t it\u003Cbr \/\u003E\nthe current religion, to let the free market set all policies?\u003C\/p\u003E\n\u003C\/div\u003E\n \u003C\/div\u003E\r\n\r\n \u003Cdiv class=\u0022response-competing\u0022\u003E\r\n \u003Cp\u003E\u003Cstrong\u003ECompeting interests: \u003C\/strong\u003E\r\n No competing interests\u003C\/p\u003E\r\n \u003C\/div\u003E\r\n\r\n \r\n \u003C\/div\u003E\r\n \u003C\/div\u003E\r\n\r\n \u003Cdiv class=\u0022rr-right-column\u0022 class=\u0022\u0022\u003E\r\n \u003Cdiv class=\u0022response-date\u0022\u003E\r\n \u003Cstrong\u003E29 January 2011\u003C\/strong\u003E\r\n \u003C\/div\u003E\r\n\r\n \u003Cdiv class=\u0022response-author\u0022\u003E\r\n Joseph More \u003C\/div\u003E\r\n\r\n \u003Cdiv class=\u0022response-occupation\u0022\u003E\r\n Retired Physician \u003C\/div\u003E\r\n\r\n \u003Cdiv class=\u0022response-other_authors\u0022\u003E\r\n \u003C\/div\u003E\r\n\r\n \u003Cdiv class=\u0022response-affiliation\u0022\u003E\r\n \u003C\/div\u003E\r\n\r\n \u003Cdiv class=\u0022response-address\u0022\u003E\r\n Retired \u003C\/div\u003E\r\n\r\n \u003Cdiv class=\u0022twitter-address\u0022\u003E\r\n \u003Ca href=\u0022https:\/\/twitter.com\/\u0022\u003E\u003C\/a\u003E \u003C\/div\u003E\r\n\r\n \u003Cdiv class=\u0022response-links\u0022\u003E\r\n\r\n \r\n \r\n \u003C\/div\u003E\r\n\r\n \u003C\/div\u003E\r\n\r\n \u003Cdiv class=\u0022rr-separator\u0022 class=\u0022clearfix\u0022\u003E\r\n\r\n \u003Cdiv class=\u0022light-grey-line\u0022\u003E\u003C\/div\u003E\r\n\r\n \u003C\/div\u003E\r\n\r\n \u003C\/div\u003E\r\n\r\n\u003C\/div\u003E\r\n \u003C\/div\u003E\n \u003Cdiv class=\u0022views-row views-row-4 views-row-even\u0022\u003E\n \r\n\u003Cdiv class=\u0022node node-highwire-comment clearfix\u0022\u003E\r\n\r\n \u003Cdiv class=\u0022row rr-header\u0022\u003E\r\n\r\n \u003Cdiv class=\u0022rr-left-column\u0022 class=\u0022\u0022\u003E\r\n\r\n \r\n \u003Cdiv class=\u0022response-title\u0022\u003E\r\n \u003Ca href=\u0022\/rapid-response\/2011\/11\/03\/reshould-spectacle-surgery-be-sold-highest-bidder\u0022\u003E\u003Ch3\u003ERe:Should the spectacle of surgery be sold to the highest bidder?\u003C\/h3\u003E\r\n \u003C\/a\u003E\r\n \u003C\/div\u003E\r\n\r\n \r\n \r\n \r\n \u003Cdiv class=\u0022content\u0022\u003E\r\n\r\n \u003Cdiv class=\u0022response-body\u0022\u003E\r\n \u003Cdiv xmlns:rsp=\u0022http:\/\/schema.highwire.org\/Service\/Response\u0022 xmlns:nlm=\u0022http:\/\/schema.highwire.org\/NLM\/Journal\u0022 xmlns:msg=\u0022http:\/\/schema.highwire.org\/Service\/Message\u0022 xmlns:c=\u0022http:\/\/schema.highwire.org\/Compound\u0022 xmlns:x=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022 xmlns:xs=\u0022http:\/\/www.w3.org\/2001\/XMLSchema\u0022 xmlns:e=\u0022http:\/\/schema.highwire.org\/Service\/HPP\/Expand\u0022 xmlns:idx=\u0022http:\/\/schema.highwire.org\/Service\/Index\u0022 xmlns:atom=\u0022http:\/\/www.w3.org\/2005\/Atom\u0022 xmlns:frz=\u0022http:\/\/schema.highwire.org\/Service\/Firenze\u0022 xmlns:xhtml=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022 xmlns:openSearch=\u0022http:\/\/a9.com\/-\/spec\/opensearch\/1.1\/\u0022 xmlns:hpp=\u0022http:\/\/schema.highwire.org\/Publishing\u0022 xmlns:app=\u0022http:\/\/www.w3.org\/2007\/app\u0022 xmlns:fs=\u0022http:\/\/sassfs.highwire.org\/Service\/Content\u0022 xmlns:l=\u0022http:\/\/schema.highwire.org\/Linking\u0022 xmlns:cache=\u0022http:\/\/sassfs.highwire.org\/Service\/Cache\u0022 xmlns:r=\u0022http:\/\/schema.highwire.org\/Revision\u0022 xmlns:req=\u0022http:\/\/schema.highwire.org\/Service\/Request\u0022 xmlns:hwp=\u0022http:\/\/schema.highwire.org\/Journal\u0022 xmlns=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022\u003E\n\u003Cp\u003E The presence of the power imbalance in the doctor-patient\u003Cbr \/\u003E\nrelationship does not extinguish a patient\u0027s capacity to weigh the pros\u003Cbr \/\u003E\nand cons of a particular course of action. In his ethical critique of a\u003Cbr \/\u003E\nsurgeon\u0027s efforts to raise money for cancer research by auctioning off an\u003Cbr \/\u003E\nopportunity to watch him operate, Simon Chapman appears to assume that it\u003Cbr \/\u003E\ndoes. \u003C\/p\u003E\n\u003Cp\u003E Chapman worries that patients about to have brain surgery won\u0027t be\u003Cbr \/\u003E\nable to consent to having ticketed observers in theatre because they \u0022will\u003Cbr \/\u003E\nbe desperate and vulnerable\u0022. However, patients consent to all manner of\u003Cbr \/\u003E\nthings in these circumstances. Most obviously they are asked to consent to\u003Cbr \/\u003E\nthe surgery itself. Similarly, though, they will often be asked to consent\u003Cbr \/\u003E\nto participate in a research project, from which they are unlikely to\u003Cbr \/\u003E\ndirectly benefit. Also, as Chapman himself points out, it is not uncommon\u003Cbr \/\u003E\nfor patients to have their operations filmed for teaching purposes or even\u003Cbr \/\u003E\nreality show entertainment.\u003C\/p\u003E\n\u003Cp\u003E The issue of concern here is not whether or not these patients are\u003Cbr \/\u003E\ncapable of consenting. The issue is whether patients know what they are\u003Cbr \/\u003E\nconsenting to and whether they feel coerced into accepting. The answers to\u003Cbr \/\u003E\nthese questions will always lie in the details around the request.\u003Cbr \/\u003E\nChapman\u0027s envisaged consent process - \u0022Oh by the way, would you be willing\u003Cbr \/\u003E\nto allow a couple of people who\u0027ve paid big money to raise funds for\u003Cbr \/\u003E\ncancer research to sit in and watch what happens to you?\u0022 - is obviously\u003Cbr \/\u003E\nunethical. Equally obviously though, it is a strawman. Proper consent to\u003Cbr \/\u003E\nthis process would involve a long discussion of exactly what is\u003Cbr \/\u003E\nenvisioned, including any risks to the patient\u0027s privacy. The surgeon\u003Cbr \/\u003E\nwould need to ensure that patients genuinely understood that they were\u003Cbr \/\u003E\nfree to refuse to participate, that a refusal would not prejudice their\u003Cbr \/\u003E\ntreatment and would not jeopardise research funds. \u003C\/p\u003E\n\u003Cp\u003E A properly informed patient would be quite able to consent, and it\u003Cbr \/\u003E\nseems most, but not all patients, are happy to participate.[1]\u003C\/p\u003E\n\u003Cp\u003E 1. Robothem J. Knives out over sale of ringside surgery seats. Sydney\u003Cbr \/\u003E\nMorning Herald 2011 (28 January). Available at URL:\u003Cbr \/\u003E\n\u003Ca href=\u0022http:\/\/www.smh.com.au\/nsw\/knives-out-over-sale-of-ringside-surgery-seats-\u0022\u003Ehttp:\/\/www.smh.com.au\/nsw\/knives-out-over-sale-of-ringside-surgery-seats-\u003C\/a\u003E\u003Cbr \/\u003E\n20110127-1a6xa.html\u003C\/p\u003E\n\u003C\/div\u003E\n \u003C\/div\u003E\r\n\r\n \u003Cdiv class=\u0022response-competing\u0022\u003E\r\n \u003Cp\u003E\u003Cstrong\u003ECompeting interests: \u003C\/strong\u003E\r\n No competing interests\u003C\/p\u003E\r\n \u003C\/div\u003E\r\n\r\n \r\n \u003C\/div\u003E\r\n \u003C\/div\u003E\r\n\r\n \u003Cdiv class=\u0022rr-right-column\u0022 class=\u0022\u0022\u003E\r\n \u003Cdiv class=\u0022response-date\u0022\u003E\r\n \u003Cstrong\u003E28 January 2011\u003C\/strong\u003E\r\n \u003C\/div\u003E\r\n\r\n \u003Cdiv class=\u0022response-author\u0022\u003E\r\n Christopher J. Ryan \u003C\/div\u003E\r\n\r\n \u003Cdiv class=\u0022response-occupation\u0022\u003E\r\n Senior Clinical Lecturer \u003C\/div\u003E\r\n\r\n \u003Cdiv class=\u0022response-other_authors\u0022\u003E\r\n \u003C\/div\u003E\r\n\r\n \u003Cdiv class=\u0022response-affiliation\u0022\u003E\r\n \u003C\/div\u003E\r\n\r\n \u003Cdiv class=\u0022response-address\u0022\u003E\r\n The Centre for Values, Ethics and the Law in Medicine, University of Sydney \u003C\/div\u003E\r\n\r\n \u003Cdiv class=\u0022twitter-address\u0022\u003E\r\n \u003Ca href=\u0022https:\/\/twitter.com\/\u0022\u003E\u003C\/a\u003E \u003C\/div\u003E\r\n\r\n \u003Cdiv class=\u0022response-links\u0022\u003E\r\n\r\n \r\n \r\n \u003C\/div\u003E\r\n\r\n \u003C\/div\u003E\r\n\r\n \u003Cdiv class=\u0022rr-separator\u0022 class=\u0022clearfix\u0022\u003E\r\n\r\n \u003Cdiv class=\u0022light-grey-line\u0022\u003E\u003C\/div\u003E\r\n\r\n \u003C\/div\u003E\r\n\r\n \u003C\/div\u003E\r\n\r\n\u003C\/div\u003E\r\n \u003C\/div\u003E\n \u003Cdiv class=\u0022views-row views-row-5 views-row-odd views-row-last\u0022\u003E\n \r\n\u003Cdiv class=\u0022node node-highwire-comment clearfix\u0022\u003E\r\n\r\n \u003Cdiv class=\u0022row rr-header\u0022\u003E\r\n\r\n \u003Cdiv class=\u0022rr-left-column\u0022 class=\u0022\u0022\u003E\r\n\r\n \r\n \u003Cdiv class=\u0022response-title\u0022\u003E\r\n \u003Ca href=\u0022\/rapid-response\/2011\/11\/03\/should-spectacle-surgery-be-sold-highest-bidder\u0022\u003E\u003Ch3\u003EShould the spectacle of surgery be sold to the highest bidder?\u003C\/h3\u003E\r\n \u003C\/a\u003E\r\n \u003C\/div\u003E\r\n\r\n \r\n \r\n \r\n \u003Cdiv class=\u0022content\u0022\u003E\r\n\r\n \u003Cdiv class=\u0022response-body\u0022\u003E\r\n \u003Cdiv xmlns:rsp=\u0022http:\/\/schema.highwire.org\/Service\/Response\u0022 xmlns:nlm=\u0022http:\/\/schema.highwire.org\/NLM\/Journal\u0022 xmlns:msg=\u0022http:\/\/schema.highwire.org\/Service\/Message\u0022 xmlns:c=\u0022http:\/\/schema.highwire.org\/Compound\u0022 xmlns:x=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022 xmlns:xs=\u0022http:\/\/www.w3.org\/2001\/XMLSchema\u0022 xmlns:e=\u0022http:\/\/schema.highwire.org\/Service\/HPP\/Expand\u0022 xmlns:idx=\u0022http:\/\/schema.highwire.org\/Service\/Index\u0022 xmlns:atom=\u0022http:\/\/www.w3.org\/2005\/Atom\u0022 xmlns:frz=\u0022http:\/\/schema.highwire.org\/Service\/Firenze\u0022 xmlns:xhtml=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022 xmlns:openSearch=\u0022http:\/\/a9.com\/-\/spec\/opensearch\/1.1\/\u0022 xmlns:hpp=\u0022http:\/\/schema.highwire.org\/Publishing\u0022 xmlns:app=\u0022http:\/\/www.w3.org\/2007\/app\u0022 xmlns:fs=\u0022http:\/\/sassfs.highwire.org\/Service\/Content\u0022 xmlns:l=\u0022http:\/\/schema.highwire.org\/Linking\u0022 xmlns:cache=\u0022http:\/\/sassfs.highwire.org\/Service\/Cache\u0022 xmlns:r=\u0022http:\/\/schema.highwire.org\/Revision\u0022 xmlns:req=\u0022http:\/\/schema.highwire.org\/Service\/Request\u0022 xmlns:hwp=\u0022http:\/\/schema.highwire.org\/Journal\u0022 xmlns=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022\u003E\n\u003Cp\u003E Reading the Views \u0026amp; reviews \u0022Should the spectacle of surgery be\u003Cbr \/\u003E\nsold to the highest bidder?\u0022 by S Chapman (BMJ 2011 342:d237;\u003Cbr \/\u003E\ndoi:10.1136\/bmj.d237) reminded me that, whenever anybody remarks that a\u003Cbr \/\u003E\nsoccer player is paid scandalously more than, say, a brain or heart\u003Cbr \/\u003E\nsurgeon, I tend to reply that this obvious injustice will be amended the\u003Cbr \/\u003E\nday a stadium full of people will pay to watch the surgeon operating. I\u003Cbr \/\u003E\nsee now it\u0027s going to happen ...\u003C\/p\u003E\n\u003C\/div\u003E\n \u003C\/div\u003E\r\n\r\n \u003Cdiv class=\u0022response-competing\u0022\u003E\r\n \u003Cp\u003E\u003Cstrong\u003ECompeting interests: \u003C\/strong\u003E\r\n No competing interests\u003C\/p\u003E\r\n \u003C\/div\u003E\r\n\r\n \r\n \u003C\/div\u003E\r\n \u003C\/div\u003E\r\n\r\n \u003Cdiv class=\u0022rr-right-column\u0022 class=\u0022\u0022\u003E\r\n \u003Cdiv class=\u0022response-date\u0022\u003E\r\n \u003Cstrong\u003E27 January 2011\u003C\/strong\u003E\r\n \u003C\/div\u003E\r\n\r\n \u003Cdiv class=\u0022response-author\u0022\u003E\r\n Massimo Porta \u003C\/div\u003E\r\n\r\n \u003Cdiv class=\u0022response-occupation\u0022\u003E\r\n Professor of Internal Medicine \u003C\/div\u003E\r\n\r\n \u003Cdiv class=\u0022response-other_authors\u0022\u003E\r\n \u003C\/div\u003E\r\n\r\n \u003Cdiv class=\u0022response-affiliation\u0022\u003E\r\n \u003C\/div\u003E\r\n\r\n \u003Cdiv class=\u0022response-address\u0022\u003E\r\n Turin University \u003C\/div\u003E\r\n\r\n \u003Cdiv class=\u0022twitter-address\u0022\u003E\r\n \u003Ca href=\u0022https:\/\/twitter.com\/\u0022\u003E\u003C\/a\u003E \u003C\/div\u003E\r\n\r\n \u003Cdiv class=\u0022response-links\u0022\u003E\r\n\r\n \r\n \r\n \u003C\/div\u003E\r\n\r\n \u003C\/div\u003E\r\n\r\n \u003Cdiv class=\u0022rr-separator\u0022 class=\u0022clearfix\u0022\u003E\r\n\r\n \u003Cdiv class=\u0022light-grey-line\u0022\u003E\u003C\/div\u003E\r\n\r\n \u003C\/div\u003E\r\n\r\n \u003C\/div\u003E\r\n\r\n\u003C\/div\u003E\r\n \u003C\/div\u003E\n \u003C\/div\u003E\n \n \n \n \n \n \n\u003C\/div\u003E \u003C\/div\u003E\n\n \n \u003C\/div\u003E\n\u003C\/div\u003E\n \u003C\/div\u003E\n\u003C\/div\u003E\n\u003C\/div\u003E\u003C\/body\u003E\u003C\/html\u003E"}